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Pregabalin removed from NI Formulary for neuropathic pain following rise in deaths

Pregabalin is no longer a “preferred option for the treatment of neuropathic pain” in new patients, following an increase in reported deaths involving the drug, community pharmacists and GPs in Northern Ireland (NI) have been told.

The medicine has been removed from the NI Formulary, which provides guidance on first and second choice medicines, assistant directors of integrated care at the Health and Social Care Board (HSCB) Joe Brogan and Margaret O’Brien told pharmacists and GPs in a letter earlier sent this month (August 4).

Prescribers have been advised to use alternative medicines such as amitriptyline and gabapentin for new patients. However, pregabalin can still be prescribed to those patients for whom it is deemed clinically appropriate.

GPs were not asked to stop prescribing pregabalin to patients currently taking it. However, the letter invited healthcare professionals to review patients on pregabalin and ensure they are “stepped down slowly as appropriate”.

A spokesperson for the HSCB told C+D: “It is evident that over the past number of years there has been an increase in the reporting of deaths that have involved pregabalin.

“Addiction services have reported the risk of dependence and misuse of pregabalin. Furthermore, drug enforcement agencies have identified the potential of pregabalin being diverted from the lawful supply chain.

“Given that there are safe and effective alternatives to pregabalin, a review of the HSCB neuropathic pain guidance has been undertaken in conjunction with clinicians and a decision has been made to remove pregabalin from the guidance and the NI Formulary.”

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